Tobacco Control has morphed into a crusade intent on demonizing both tobacco users and the industry supplying them. This blog examines and comments on scientific issues surrounding tobacco policies - and fallacies.

Tuesday, January 29, 2013

I
am not inclined toward political action, but I am inspired by Clive Bates’s call
to action against the European Union’s appalling new tobacco directive (here).Americans should take action at home as well,
in support of tobacco harm reduction and an open U.S. market for vastly safer
smoke-free products.I have long argued
for this in my blog and at my Smokers Only website (here).

Bates
describes the EU directive as doing “three main bad things,” which are
analogous in the U.S. to local, state and federal tobacco-prohibition efforts.The strategies are the same.The EU directive, he writes:

1. Bans snus,
the least hazardous form of tobacco known to mankind, whilst allowing
cigarettes to be widely sold.Snus (or
oral tobacco) is much less dangerous than cigarettes, and widely used in
Sweden, where it is the main reason why Sweden has much lower rates of cancer
and other smoking-related disease than anywhere else in Europe.

Why ban these
products when they have been so successful at reducing harm in Sweden?

2. Treats
e-cigarettes as though they are medicines – effectively banning or
marginalising them…

3. Prevents any
claim that one tobacco product is less harmful than another. The truth is that
smokeless tobacco products may be many times less harmful than cigarettes,
perhaps 10-1000 times less harmful.So
what looks like an attempt to stop false or excessive claims, is actually going
to do real harm:

It denies
consumers the most relevant information about lower risk tobacco products –
information they could use to reduce their own risk and protect their health.
This is misleading by omitting the most important information.

Why should a
manufacturer bother to make or market these products or invest in innovation if
they can’t say the one (truthful) thing that makes them valuable as
alternatives to cigarettes? All this does is reinforce the market for the most
harmful tobacco products by shielding them from competition from less harmful
forms.

This makes a law
out of misleading consumers – who benefits from it?

Bates
encourages tobacco users to write representatives in their home country and in the
EU parliament. American tobacco consumers
who are fed up with unscientific and inappropriate U.S. laws and regulations should
do the same with their elected officials and government institutions.

In
other words, tobacco users should engage in political and policy matters that
threaten your rights.You need to protest
if your city or state attempts to impose TIP-TOE (Tacit Incremental Prohibition - Tobacco Elimination),
which involves banning nearly risk-free smokeless tobacco and e-cigarettes and
assuring the continued market dominance of killer cigarettes (here).

You
should respond by writing your public officials – mayor, city council members,
governor, state and federal legislators.I have adapted Bates’s Euro-centric suggestions for Americans who wish
to express their views.

1. Be decent. Always be polite and dignified, don’t make
accusations or question motives – most public officials want to do a good job.

2. Be engaging. Assume the official is open-minded but might
need some persuading. Don’t dismiss
other views; tackle them.

4. Be natural. Formal language and legal terms aren’t
required; it’s their job to understand you, not your job to understand the
technicalities of legislation.

5. Be concise. Concentrate on the things that really matter
to you and stay focused – if you are writing about e-cigarettes, don’t dilute
your message with views on other issues. Keep it short (max two pages or 800 words) and
to the point.

6. Be personal. E-mail each legislator individually.You can use the same basic text with each,
but the personal touch goes a long way.

7.Be relevant. When writing to Congress, for example, only
write to your own legislators.

Bates
also offers some great content suggestions:

1. Write about your own experience – e.g., have
you tried to quit smoking? What
experience have you had with e-cigarettes or smokeless tobacco use?

2. Tell why you
think the proposed action will hurt you personally.

3. Suggest what the official ought to do.

4. Ask questions
that require a response; ask for a reply or a meeting.

5. Explain how the proposed action may limit
smokers’ options to quit cigarettes by switching to products that are much less
risky, resulting in more smoking-related death and disease.

6. Describe how
the proposed action could tie e-cigarettes in regulatory red tape, effectively
banning these products by the back door.It makes no sense to ban safer products while leaving dangerous
cigarettes on the market.

7. Explain why the
proposed action will make smoke-free products less attractive, more expensive
and less innovative – for example by banning flavors, making the packaging look
like medicine, and limiting advertising and marketing.

8. Tell the
official why it is wrong to pretend that all tobacco and nicotine products are
the same – smokers should have accurate information about risks so they can
make informed choices.

9. Explain why all smokeless tobacco products are
much safer than cigarettes and are viable substitutes for smoking.Smokers should not be denied this option.

10. Convince officals that e-cigarettes should be
regulated for what they are – consumer products, placed on the market as
alternatives to cigarettes.

11. Note that if e-cigarettes are removed from the
market, vapers will return to smoking.

12. Tell officials
that government should encourage smokers to switch to e-cigarettes or smokeless
tobacco, not ban or marginalize these products through regulation.

I
will add one more content tip that is especially relevant to Americans: Strongly
object to tobacco prohibitionists’ baseless claim that adult access to safer
tobacco products is a problem for children.It isn’t a children’s issue.FDA regulation
will ensure that tobacco companies don’t advertise or sell tobacco to children.There are 45 million smokers in the U.S., and
the eight million who will die from smoking-related illnesses in the next 20
years are not children today; they are adults, 35 years and older.Preventing youth access to tobacco is vitally
important, but that effort should never be used as a smokescreen to condemn
smoking parents and grandparents to premature death.

In
the U.S., the Consumer Advocates for Smoke-Free Alternatives Association (here) is active on
e-cigarette issues.They post calls to
action on their website, and members of CASAA’s board of directors, including
Elaine Keller, Kristin Noll-Marsh, Gregory Conley and Carl V. Phillips, are credible,
persuasive spokespersons on the full range of smoke-free tobacco issues.

Smokeless
tobacco users and switchers should take CASAA’s approach.This post gives you some basic tools.Get involved!

Wednesday, January 23, 2013

A study
published this month in Nicotine and Tobacco
Research (abstract here) provides
evidence that coverage of smokeless tobacco (ST) in the context of tobacco harm
reduction was infrequent and negatively slanted during the period 2006 through
2010. The lead author was Dr. Olivia Wackowski from the University of Medicine
& Dentistry of New Jersey, with coauthors from her institution and from the
University of California San Francisco.

The
authors searched for articles primarily about ST in the Wall Street Journal,
the New York Times and USA Today, and in the top 2-4 newspapers in each
state.She also searched national news
services (Associated Press, Reuters, UPI), the Winston-Salem Journal (home of
RJ Reynolds), The Richmond Times (home of Altria) and health wire news
services.

Only
130 ST articles focused on tobacco harm reduction (lumped with new products and
product regulation), a low number considering the subject’s potential to save
millions of lives.Of these, only
“…about 58%... referred to ST products as being [or] possibly being less risky
or harmful than smoking.”This category
also had the highest percentage of articles (69%) with references to health
risks, but it is likely that few of them were positive.Tobacco hometown newspapers contributed the
most articles to this category (38%), followed by state papers (35%) and
national papers (23%).

The
researchers also found 176 “opinion” articles; 89 were letters to the editor,
70 were editorials and 17 were op-ed pieces.Unfortunately, 64% were classified by the researchers as anti-ST, only 26%
were pro-ST, and the remainder were neutral.Of the 61 articles in the harm reduction category, 43% were pro-ST.

One
positive note: The use of the derogatory term “spit tobacco” was uncommon,
except in state newspapers (15%).

In
short, coverage of ST has been scant and heavily biased against and tobacco
harm reduction.This is unsurprising,
given the national misinformation campaign that I discussed previously (here).

Thursday, January 17, 2013

Dr.
Phil Cole and I asserted in 2008 that smoking-related deaths in the U.S were on
the decline. Finally, this month, an FDA official arrived at the same conclusion
in a journal article.

In “Calculating the Big Kill,” which appeared in
Regulation, the Cato Institute’s
flagship publication (here), I made the case
that “CDC [Centers for Disease Control and Prevention] estimates of
smoking-related deaths do not add up.”I
noted that “U.S. smoking rates have been declining almost continuously since
the mid-1960s, when 42 percent of American adults smoked.The rate dropped to 28 percent in 1988 and
has now declined to 21 percent.Put
simply, the proportion of Americans who smoke has been cut in half over the
past 40 years.”

I asked, “Why have the CDC [big-kill] estimates not fallen?”

My question was based on a
research study that Dr. Cole and I published a year earlier in Nicotine and Tobacco Research (abstract
here), showing that
“there were 402,000 deaths attributable to smoking in 1987 and 322,000 in 2002.”We noted that despite the substantial decline
in smoking prevalence, the estimate of smoking-attributable deaths from the
Centers for Disease Control and Prevention had changed hardly at all.Five
years later, my question is still relevant.The answer is clear: The CDC chose not to acknowledge the fact that deaths
had plummeted.

Brian Rostron, a scientist at the
FDA, has now published a study, also in Nicotine
and Tobacco Research (abstract here),
demonstrating that smoking-attributable deaths declined from 398,000 in 2000 to
370,000 in 2007.

As I explained in my Cato
article, most people mistakenly believe that CDC officials actually count the
number of smokers who die each year.The
truth is that the CDC uses a model that estimates the number of current and
former smokers based upon data in the National Health Interview Survey (NHIS);
the CDC subjects those smoker estimates to relative risks developed by the
American Cancer Society in the 1980s, and then produces an estimate of the
number of deaths that would not have occurred if they had never smoked.Like any model, the quality of the output is
dependent on the quality of the input.

I had noted that the CDC was
using 20-year-old data to produce its “big-kill” estimates; Dr. Rostron concurs,
saying that “the CDC has not substantially revised the methodology or data that
are used in this procedure since their introduction in the 1980s.”

Rather than using decades-old
risk estimates, Dr. Rostron updated the relative risks for smokers and former
smokers by calculating them from NHIS subjects from 1997 to 2004 who were
followed through 2006 with linkage to the National Death Index.Unlike the outdated CDC estimates, he adjusted
risks for age, race/ethnicity, education, alcohol consumption and body mass
index, which are important confounding factors for some or all smoking-related
diseases.

Here are Dr. Rostron’s big-kill
estimates:

Smoking-Attributable Deaths Among Men and Women in the U.S., 2000, 2004 and 2007

Year

Men

Women

All

2000

211,000

187,000

398,000

2004

200,000

180,000

380,000

2007

195,000

175,000

370,000

Although declining, Dr. Rostron’s
big-kill numbers may still be too high because of the way he estimated deaths among
former smokers.Using his model, former
smokers accounted for about 177,000 out of the 370,000 deaths from smoking in
2007.This seems to be excessively high,
as the 2007 NHIS documents that 60% of the 39 million former smokers had quit
over 15 years previously.Any excess
risk for a smoking-attributable death was minimal to nonexistent in this
group.

Dr. Rostron’s deaths among former
smokers were likely concentrated in those who quit less than 5 years earlier, and
who therefore have risks similar to those of current smokers.But it is inconceivable that this group of
6.3 million former smokers produced almost as many deaths as the 27.5 million
current smokers in 2007.Dr. Rostron’s
model should be revised to reflect the different risks among former smokers who
have short or long quitting histories.

Regardless, the main message of
this study is valid: Smoking-attributable deaths have been in decline for over
a decade.This is good news that the CDC
and other federal agencies have ignored for far too many years.

My Credentials

I am a Professor of Medicine at the University of Louisville, I hold an endowed chair in tobacco harm reduction research, and I am a member of the James Graham Brown Cancer Center at U of L.

For the past 20 years I have been involved in research and policy development regarding tobacco harm reduction (THR). THR advocates acknowledge that there are millions of smokers who are unable or unwilling to quit with conventional cessation methods involving tobacco and nicotine abstinence, and we encourage them to use cigarette substitutes that are far safer.

My research has appeared in a broad range of medical and scientific journals. I have authored commentaries in the general press and I wrote the book, For Smokers Only: How Smokeless Tobacco Can Save Your Life. In 2003 I served as an expert witness at a Congressional hearing on tobacco harm reduction, and I have spoken at numerous international forums, including one held in London at the British Houses of Parliament.

My research is supported by unrestricted grants from tobacco manufacturers to the University of Louisville and by the Kentucky Research Challenge Trust Fund.